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Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.

Jennifer R Kogan1, Lisa N Conforti, Kenji Yamazaki

  • 1J.R. Kogan is professor of medicine and assistant dean of faculty development, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. L.N. Conforti is research associate for milestones evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. When this study was conducted, she was research associate for academic programs, American Board of Internal Medicine, Philadelphia, Pennsylvania. K. Yamazaki is outcome assessment project associate, Accreditation Council for Graduate Medical Education, Chicago, Illinois. W. Iobst is vice president for academic and clinical affairs and vice dean, Commonwealth Medical College, Scranton, Pennsylvania. When this study was conducted, he was vice president of academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. When this study was conducted, he was chief medical officer and senior vice president, American Board of Internal Medicine, Philadelphia, Pennsylvania.

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Faculty development in assessment is crucial for medical education. While motivation aids change, time constraints and competing priorities often hinder implementation of new teaching strategies.

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Area of Science:

  • Medical Education
  • Faculty Development
  • Assessment in Healthcare

Background:

  • Effective faculty development is essential for improving the quality of trainee assessments.
  • Competency-based education relies on robust assessment practices.
  • Understanding faculty intentions and implementation challenges post-training is limited.

Purpose of the Study:

  • To explore faculty intentions for change after workplace-based assessment rater training.
  • To assess faculty's ability to implement intended changes.
  • To identify predictors of change and encountered barriers.

Main Methods:

  • 45 internal medicine faculty preceptors participated in rater training.
  • Commitment to change forms and motivation/difficulty rankings were collected.
  • Follow-up interviews assessed implementation and barriers; logistic regression identified predictors.

Main Results:

  • Most commitments focused on improving teaching (57%) and increasing direct observation (31%).
  • 39% of changes were fully implemented, 40% partially, and 20% not at all.
  • Higher motivation predicted change, while anticipated difficulty and lack of time were barriers.

Conclusions:

  • Faculty motivation is a key predictor of implementing changes after training.
  • System-level barriers, such as time constraints, significantly impede implementation.
  • Faculty development programs should address the interplay between motivation and organizational barriers.